Should CBD be part of your pain management plan? Of all the reasons people report using CBD today, pain is the most common condition cited. In the United States, over seventy million people suffer from chronic pain, which is defined as experiencing over one hundred days of pain per year. The endocannabinoid system is one of the body’s key systems involved in regulating pain sensation (1) and cannabinoids in CBD have multiple mechanisms of action.
Two cannabinoid receptors are known to exist in the human body: CB1 and CB2 receptors. They are found at almost every level of the pain pathway from peripheral sites, such as peripheral nerves and immune cells, to central nervous system sites such as the spinal cord and higher brain regions associated with descending control of pain (2). Cannabinoids affect the transmission of pain signals from the affected region to the brain (ascending) and from the brain to the affected region (descending).
Cannabinoids can be used along with opioid medications, and a number of studies have demonstrated they can reduce the amount of opioids needed, lessen the buildup of tolerance, and reduce the severity of withdrawal. At least ten randomized, controlled trials on over one thousand patients have demonstrated efficacy of cannabinoids for neuropathic pain of various origins.
Full-Spectrum CBD Oil and Pain
A full-spectrum CBD oil is typically ideal because it contains CBD and additional cannabinoids (ie: CBC and CBG) shown to support healthy pain management, including manage stiffness, soreness and discomfort. When all the constituents in the hemp plant work together, this is known as the "entourage" or "ensemble" effect. Research has shown CBD, THC, and other individual components work synergistically, so the medicinal impact of the whole plant is far greater than that of the separate compounds. Here are additional reasons to choose a full-spectrum CBD oil rather than a CBD isolate.
Terpenes and Pain
Another family of compounds found in hemp are terpenes, and they provide additional temporary pain relief and increase the effectiveness of other cannabinoids, as a result of the entourage effect. Terpenes are an important part of the hemp plant and give the plant its unique odor and flavor profile. Look for hemp high in these specific terpenes: beta-caryophyllene, myrcene and linalool.
Most ingested products take thirty to sixty minutes before taking effect, and even faster on an empty stomach. The effects last six to eight hours.
How to Take CBD: Dosage and Delivery
If you’re planning to use CBD, it’s important to experiment with the dosage and delivery method since everyone reacts differently. Oral CBD products with a ratio of 20:1 or higher and administered as drops, capsules, or edibles can be very effective in treating pain, especially the inflammatory type. Most discussions of treating pain with CBD suggest finding the right dosage is critical. To do this, carefully monitor your condition and experiment to find the right formula; 10-40 mg of CBD is usually enough, but always start with a lower dose to test sensitivity and go up as needed.
Topical CBD for Pain
The skin has the highest amount and concentration of CB2 receptors in the body. When pain is localized, topical products can be applied. These can be made using CBD-dominant cannabis as well as THC strains. Topicals affect the cells near application and through several layers of tissue but do not cross the blood-brain barrier and are, therefore, not psychoactive. These may be available as oils, ointments, salves or other forms, and with varying ratios of CBD and THC (a ratio of 1:1 is often recommended as ideal for skin application).
Kelly Harrington, MS, RDN
Registered Dietitian Nutritionist for Healthy Goods
1. Woodhams SG et al. The role of the endocannabinoid system in pain. Handb Exp Pharmacol. 2015;227:119-43.
2. Burston JJ et al. Endocannabinoid system and pain: an introduction. Proc Nutr Soc. 2014 Feb;73(1):106-17.
3. Leinow, L and Birnbaum J. CBD A Patient's Guide to Medicinal Cannabis. North Atlantic Books. Berkeley, CA. 2017.